Provider Demographics
NPI:1548731813
Name:LYNCH, BETH
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 FUCHSIA DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2364
Mailing Address - Country:US
Mailing Address - Phone:972-302-1038
Mailing Address - Fax:281-644-1846
Practice Address - Street 1:1736 KATYLAND DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-1751
Practice Address - Country:US
Practice Address - Phone:281-237-6647
Practice Address - Fax:281-644-1846
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08-3600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist